Intranasal abuse of prescription hydrocodone/acetaminophen results in oronasal fistula: A case report

Abstract

Opioids are becoming more common in the treatment of chronic nonmalignant pain. With increased availability of opioids for chronic pain we may expect an increased misuse of these as analgesics as well. The authors describe the case report of a young woman with chronic back pain and intranasal abuse of prescribed hydrocodone/acetaminophen who was diagnosed after presenting for hypernasal speech and foreign body in the nose. This case report highlights the need for vigilance on the part of the physician for any aberrant drug-related behaviors. Any unusual symptoms or signs such as hypernasal speech, chronic nasal infection, or unexplained foreign body sensation in the nose should be thoroughly investigated.

An unusual case of rapidly forming severe oral lesions involving bacterial infection in a dog

“…Oronasal fi stula is an acquired communication between the oral and nasal cavities caused in dogs by trauma (e.g., bite wounds, blunt head trauma, gunshot wounds, electrical burns, foreign body penetration and pressure necrosis, including nasopharyngeal stents) [1], neoplasia, radiation necrosis, dental disease and dehiscence after surgical treatment [2], the latest possibly complicated by nasal aspergillosis [3]. In humans, certain chemicals/drugs [4] and rhinoliths [5] have also been described to cause oronasal fi stulae. Fungal and actinomycotic infections of the oropharynx may also result in subacute, invasive infl ammatory processes with extensive tissue necrosis and oronasal fi stulation in humans [6,7].…”

Intranasal tissue necrosis associated with opioid abuse: Case report and systematic review

“…Nine studies were included in qualitative analysis, with identification of 61 patients (female n 5 35, 57%) from four case series 5,8,9,13 and five case reports 6,7,10,14,15 (level of evidence IV/V). Summaries of included studies are presented in Table I..…”